Dr. Damiano Caruso, PhD.
And combining clinical data with baseline chest CT exam findings is an effective way to predict which COVID-19 patients are at higher risk of these types of long-term effects, wrote a team led by Dr. Damiano Caruso, PhD, of Sapienza University of Rome.
"[Our study found that] at six-month follow-up, 72% of patients showed late sequelae, in particular fibrotic-like changes," the team wrote. "Baseline LSS [Lung Severity Score] and QCCT [quantitative chest CT] of well-aerated lung showed an excellent performance in predicting [these] changes at six-month chest CT."
Chest CT findings for COVID-19 have been thoroughly explored, but mostly as they manifest in the short- and midterm of disease progression, the team noted. Further research on the disease's long-term effects is needed.
Caruso's group sought to add to the knowledge base regarding COVID-19's lasting sequelae and to investigate whether baseline chest CT findings and/or clinical data could help predict whether patients will have lung thickening at six-month follow-up.
The team conducted a study that included 118 patients who had moderate to severe COVID-19 disease between March and May 2020 (all patients' disease was confirmed by reverse transcription polymerase chain reaction [RT-PCR] testing). All underwent baseline chest CT exams and follow-up exams at six-months; the researchers assessed the exams' qualitative findings, LSS, and QCCT measures, comparing them with baseline CT exam findings. The team assessed three strategies for predicting long-term COVID-19 effects: clinical data alone, radiological data alone, and a combination of the two methods.
At six-month chest CT follow-up, 72% of patients had fibrotic-like changes in their lungs and 42% showed ground-glass opacities. The investigators found that baseline LSS and QCCT scores were effective predictors of fibrotic-like changes at this follow-up exam.
(a,b) Baseline and (c,d) six-month follow-up coronal thin-section unenhanced chest CT scans of 79-year-old man, admitted to the emergency department presenting fever, dyspnea, and cough; COVID-19 was confirmed by RT-PCR testing. (a) Chest CT scan shows bilateral ground-glass opacities tending to consolidation (black arrow). (b) The same scan after QCCT analysis highlighted in light-blue well-aerated lung (1.5 liters, 50%) and in yellow pulmonary injury of COVID-19 pneumonia. (c) Six-month follow-up scan shows residual fibrotic-like changes (white arrows) and persisting of low-density ground glass (asterisks). (d) The same scan after QCCT analysis highlighted in light-blue well-aerated lung (3.5 liters, 82%) and in yellow residual findings of COVID-19 pneumonia at six months follow-up. Images and caption courtesy of the RSNA.
Performance of three different strategies for predicting fibrotic changes in COVID-19 patients at six-month follow-up
|
Measure |
Clinical data |
Radiological data |
Combination |
Area under the curve |
0.89 |
0.81 |
0.92 |
Sensitivity |
82% |
84% |
100% |
Specificity |
93% |
67% |
73% |
However, in an accompanying editorial, Dr. Athol Wells and colleague Dr. Anand Devaraj, both of Imperial College London in the U.K., suggested that Caruso and colleagues may not be approaching assessment of post-COVID-19 lung changes in the most effective way.
"Each and every participant with residual disease at six months had a positive 'fibrotic-like' score: Quite simply, the prediction of 'fibrotic-like' abnormalities from baseline data was no more than a prediction of the presence of residual disease," they wrote. "The apparent increase in the prevalence of [these changes] at six months is highly deceptive, as baseline scans were performed at admission, not when the disease was most severe. ... A more progressive lung fibrosis hypothesis post-COVID would instead require evaluating change from baseline CT performed at discharge from intensive care or hospital discharge."
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